Surgery of brainstem cavernous malformations: surgical nuances and outcomes of a monocentric series of 34 patients.

Background: Brainstem cavernous malformations (BCM) constitute one of the most controversial and challenging neurological pathologies: both natural course and surgical manipulation can lead to severe neurological symptoms by direct compression or following hemorrhage of this highly eloquent brain region.

Methods: The vascular section of the prospectively collected neurosurgical database of our center (2011-2023) was retrospectively reviewed, seeking all patients operated on for a sporadic BCM. Clinical, radiological and surgical data, operative records and videos were analyzed by independent reviewers with the assistance of a dedicated neuropsychologist, blinded to the hospital course.

Human placenta in vascular neurosurgery training: a comprehensive review of laboratory models, possible exercises, and assessments for skills improvement.

Introduction: Simulation is increasingly recognized as an important tool to enhance neurosurgical education. In this field, especially in neurovascular surgery, human placenta (hPl) is being recognized as a valuable training model because of its abundant availability, ethical acceptance, and analogous vasculature with other vessels of the human body. Nevertheless, although a rising body of literature is witnessing a renovated interest toward this "old" model, to date no comprehensive reviews on the topics are available.

Proposal of a predictive score for the occurrence of postoperative cerebral vasospasm: analysis of a large single institution retrospective series and literature review.

Despite being uncommon, postoperative vasospasm (PoVS) present notably high morbidity and mortality rates. Our aim was to identify prognostic factors associated with this condition and introduce a scoring system to improve subsequent clinical and radiological surveillance strategies. We conducted a retrospective analysis of our institutional database covering patients aged over 18 who underwent craniotomic or transsphenoidal surgery for elective tumor removal at the Neurosurgical Unit of our institution between January 2016 and August 2023.

Trigeminal neuralgia in multiple sclerosis: proposal of surgical flowchart and long-term outcome evaluation in a mono-istitutional cohort.

Background: Trigeminal neuralgia (TN) is a chronic pain syndrome more prevalent in patients with multiple sclerosis (MS), often presenting with earlier onset and more intense pain compared to non-MS patients. The management of TN in MS is complex due to the interaction between demyelination and neurovascular factors.

Methods: A retrospective analysis of 35 MS patients treated for TN with 65 procedures between 2010 and 2023 was conducted.

Choroid plexus tumors in adults: a retrospective mono-institutional study.

Purpose: Choroid plexus tumors (CPT) are rare entities, and even rarer in adulthood.

Methods: A retrospective consecutive series of 24 adult CPT patients was reviewed.

Results: We described 24 adult CPTs.

Incidence, epidemiology, radiology, and classification of metastatic spine tumors: WFNS Spine Committee recommendations.

Spinal metastasis (SMs) are the most encountered tumors of the spine. Their occurrence is expected roughly around one to two years after primary tumor diagnosis. Since the advent of Magnetic Resonance Imaging (MRI), this technology has been considered the gold standard for SMs diagnosis and characterization due to its precise ability to comprehend the rate of soft tissue compression/invasion (dural sac/nervous tissue), which is one of the main drivers of management strategies.

High-Definition 4K-3D Exoscope in Spine Surgery: A Single-Center Experience and Review of the Literature.

: Binocular optical microscopy (OM) paved the way for a new era in brain and spine neurosurgery fields with the introduction of microsurgery. Despite its enormous contribution to modern neurosurgery, OM presents some intrinsic limitations that surgeons need to face during procedures such as prolonged non-ergonomic positions and decreased vision quality to the assistant eyepiece. To overcome these limitations, in recent years, new operative tools have been introduced, such as exoscopes.

Intraoperative confocal laser endomicroscopy during 5-aminolevulinic acid-guided glioma surgery: significant considerations for resection at the tumor margin.

Objective: Because gliomas have poorly defined tumor margins, the ability to achieve maximal resection is limited. To better discern these margins, fluorescence-guided surgery has been used to aid maximal safe resection. The authors describe their experience with the simultaneous use of intraoperative fluorescein sodium (FNa) confocal laser endomicroscopy (CLE) and operating microscope 5-aminolevulinic acid (5-ALA) fluorescence imaging for glioma resection to improve CLE use for better margin discrimination.

Intraoperative confocal endomicroscopy of the glioma margin: performance assessment of image interpretation by neurosurgeon users.

Objectives: Confocal laser endomicroscopy (CLE) is an intraoperative real-time cellular resolution imaging technology that images brain tumor histoarchitecture. Previously, we demonstrated that CLE images may be interpreted by neuropathologists to determine the presence of tumor infiltration at glioma margins. In this study, we assessed neurosurgeons' ability to interpret CLE images from glioma margins and compared their assessments to those of neuropathologists.

Integrative approaches in spinal cord stimulation: Neuropathic pain management and motor recovery in spinal cord injury. A narrative review.

Introduction: Spinal cord stimulation is a widespread treatment of chronic neuropathic pain from different conditions. Several novel and improving technologies have been recently developed to increase the effect of neuromodulation in patients refractory to pharmacological therapy.

Research Question: To explore spinal cord stimulation's mechanisms of action, indications, and management.

Exoscopic-assisted posterior approach for the removal of thoracic dumbbell schwannoma: Three-dimensional operative video.

"Dumbbell" tumors are described as benign neoplasms presenting both intraspinal and extraspinal extensions, connected through the intervertebral foramen (McCormick, 1996) [1]. About 90 % of such tumors are histologically classified as schwannomas that most frequently arise in the thoracic region (Takamura and et al., 1997) [2].

The Application of Sodium Fluorescein in Resection of Medulloblastoma Under YELLOW 560 Filter: Feasibility and Preliminary Results of a Monocentric Cohort and Systematic Review.

Background: Maximizing surgical resection of medulloblastoma (MB) affects overall survival; nevertheless, surgical resection remains a because of the infiltrative behavior of this tumor. Several dyes have been tested for improving tumor visualization; however, few reports with different protocols of fluorophores use are available and the results are inconsistent. Hence, we report our experience with sodium fluorescein in MB surgery, aiming to assess the role of this technique on the extent of resection.

Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension.

Background: Meningoencephalocele is defined as an abnormal sac of brain tissue and meninges extending beyond natural skull margins, often leading to cerebrospinal fluid (CSF) leakage. When this condition arises in the spheno-ethmoidal region, the diagnosis becomes more challenging as it can be mistaken for other nasal pathologies, such as mucocele.

Research Question: We show in this case report a non-congenital sphenoethmoidal meningoencephalocele causing rhinoliquoral fistula and spontaneous intracranial hypotension.

What have we learned in fluorescein-guided resection of brain metastases? An update after 79 consecutive cases.

Background: Cerebral metastasis (CM) is the most common malignancy affecting the brain. Individualized treatment of CM still represents a challenge for neuro-oncological teams: in patient eligible for surgery, complete tumor removal is the most relevant predictor of overall survival (OS) and neurological outcome. The development of surgical microscopes harboring specific filter able to elicit the fluorescent response from sodium fluorescein (SF) has facilitated fluorescein-guided microsurgery and the identification of pathological tumor tissue, especially at the tumor margins.

A Brief Explanation on Surgical Approaches for Treatment of Different Brain Tumors.

The main goal of brain tumor surgery is to achieve gross total tumor resection without postoperative complications and permanent new deficits. However, when the lesion is located close or within eloquent brain areas, cranial nerves, and/or major brain vessels, it is imperative to balance the extent of resection with the risk of harming the patient, by following a so-called maximal safe resection philosophy. This view implies a shift from an approach-guided attitude, in which few standard surgical approaches are used to treat almost all intracranial tumors, to a pathology-guided one, with surgical approaches actually tailored to the specific tumor that has to be treated with specific dedicated pre- and intraoperative tools and techniques.

Towards a common language in neurosurgical outcome evaluation: the NEON (NEurosurgical Outcome Network) proposal.

Background: The aim of this study was to achieve a consensus on the minimum set of outcome measures and predictors to be used in the neurosurgical practice and on the timing of outcome assessment.

Methods: A consensus building approach was employed. All neurosurgical departments in Lombardy (Italy) were invited to participate by the Carlo Besta Neurologic Institute IRCCS Foundation.

Sporadic spinal psammomatous malignant melanotic nerve sheath tumor: A case report and literature review.

Background: Sporadic Spinal Psammomatous Malignant Melanotic Nerve Sheath Tumor (SSP-MMNST) is a rare subgroup of peripheral nerve sheath tumors arising along the spine. Only a few reports of SSP-MMNST have been described. In this paper, we review the literature on SSP-MMNST focusing on clinical, and diagnostic features, as well as investigating possible pathogenetic mechanisms to better implement therapeutic strategies.

Are Thalamic Intrinsic Lesions Operable? No-Man's Land Revisited by the Analysis of a Large Retrospective, Mono-Institutional, Cohort.

Thalamic gliomas represent a heterogeneous subset of deep-seated lesions for which surgical removal is advocated, although clear prognostic factors linked to advantages in performance status or overall survival are still lacking. We reviewed our Institutional Cancer Registry, identifying patients who underwent surgery for thalamic gliomas between 2006 and 2020. Associations between possible prognostic factors such as tumor volume, grade, the extent of resection and performance status (PS), and overall survival (OS) were evaluated using univariate and multivariate survival analyses.

Towards an Established Intraoperative Oncological Favorable Tool: Results of Fluorescein-Guided Resection from a Monocentric, Prospective Series of 93 Primary Glioblastoma Patients.

It is commonly reported that maximizing surgical resection of contrast-enhancing regions in patients with glioblastoma improves overall survival. Efforts to achieve an improved rate of resection have included several tools: among those, the recent widespread of fluorophores. Sodium fluorescein is an unspecific, vascular dye which tends to accumulate in areas with an altered blood-brain barrier.